Study of digoxin use in a public health unit

Abstract

Digoxin is used for heart failure associated to systolic dysfunction and high ventricular rate. It has a narrow therapeutic range and intoxication may occur due to drug interactions or comorbidities. The aim of this work was to study digoxin use in a public health unit delineating the profile of patients susceptible to digitalis intoxication. Medical records belonging to patients admitted to the cardiomyopathy ward of the health unit (2009)(2010) and in use of digoxin were analyzed. Among 647 patients admitted, 185 individuals using digoxin and possessed records available. The registration of plasma digoxin concentration was found in 80 records and it was out of the therapeutic range in 42 patients (52.5%). This group of individuals was constituted mainly by males patients (79%), functional class III of heart failure (65%), exhibiting renal failure (33%). The evaluated sample reflects the epidemiology of heart failure in Brazil and, although pharmacotherapy had been according to Brazilian Guidelines, apparently the monitoring was not performed as recommended. This work highlighs the necessity of plasma digoxin constant monitoring during pharmacotherapy and the development of protocols that enable a safer use, especially in male patients, functional class III and with renal dysfunction.

Association of Digoxin Application Approaches With Long-Term Clinical Outcomes in Rheumatic Heart Disease Patients With Heart Failure: A Retrospective Study

“…Finally, the all-cause death risk in male RHD patients with cDGX above the corresponding SDC cutoff value (0.6, 0.8, and 1.0 ng/ml) was approximately increased by 40% compared to that in their female counterparts while CVD risk was at least 90% (Supplementary Table 2). A similar phenomenon was also seen in a previous study (25), but was inconsistent with another study that reported that DGX therapy was related to elevated all-cause death in women (26). The sex-related differences in the effect of DGX among HF patients need further research.…”

Relatos de professoras de Sala de Recursos Multifuncional sobre as condições de trabalho na escola

“…Vários pesquisadores têm investigado e discutido as funções do professor de AEE (KASSAR, 2011;MENDES et al, 2015;FERREIRA et al, 2017;CARAMORI et al, 2018;BERG et al, 2020) LIMA, 2015;MIRANDA, 2016;ALCANTARA et al, 2016;. Estudos apontam para a importância da adoção de práticas colaborativas entre os professores, famílias e demais profissionais envolvidos no processo de inclusão escolar (GIVIGI et al, 2015;GIVIGI et al, 2016;MARQUES;GIROTO, 2016;ALCANTARA et al, 2016;RAMOS;MENDES, 2017;CASTELLANOS-PATIÑO, 2018). Essas investigações revelam lacunas importantes na formação inicial e continuada de professores, sobre a compreensão do modelo inclusivo e da necessidade de se criar estratégias para que haja articulação entre os envolvidos no processo.…”

Electrochemical Na+ and Ca2+ gradients drive coupled-clock regulation of automaticity of isolated rabbit sinoatrial nodal pacemaker cells

“…We interpreted this gross arrhythmic APCL stage of the response to DG to reflect marked clock uncoupling(41). The steep relationships between the degree of clock coupling and increase in [Na ϩ ] i and reduction in E Na Ϫ E Ca (or change in 3E Na Ϫ 2E Ca ) would appear to be an underpinning of the well-recognized narrow therapeutic:toxic ratio of DG compounds(31,37).Stereotyped responses of excitable cardiac tissue and cells to DG. The pattern of APCL responses of single SANCs in the present study over a range of increases of [Na ϩ ] i and [Ca 2ϩ ] i MDP depolarization, and a progressive reduction in E Na and E Ca over time following DG exposure, bears a striking resem-blance to that measured in intact sinus node (SAN) tissue in response to a high DG concentration…”